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Infections

Impact of early CMV reactivation in cord blood stem cell recipients in the current era

Bone Marrow Transplantation volume 51, pages 1113–1120 (2016)Cite this article

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Abstract

Several studies have reported an association between CMV reactivation and a decreased incidence of relapse for AML after adult donor allogeneic hematopoietic cell transplantation (HCT). Limited data, however, are available on the impact of CMV reactivation on relapse after cord blood (CB) stem cell transplantation. The unique combination of higher incidence of CMV reactivation in the seropositive recipient and lower incidence of graft versus host disease (GvHD) in CB HCT permits a valuable design to analyze the impact of CMV reactivation. Data from 1684 patients transplanted with CB between 2003 and 2010 for AML and ALL were analyzed. The median time to CMV reactivation was 34 days (range: 2–287). CMV reactivation and positive CMV serology were associated with increased non-relapse mortality (NRM) among both AML and ALL CB recipients (reactivation, AML: relative risk (RR) 1.41 (1.07–1.85); ALL: 1.60 (1.14–2.23); Serology, AML: RR 1.39 (1.05–1.85), ALL: RR 1.61 (1.18–2.19)). For patients with ALL, but not those with AML, this yielded inferior overall survival (P<0.005). Risk of relapse was not influenced by CMV reactivation or positive CMV serostatus for either disease.

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Acknowledgements

The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from Alexion; *Amgen Inc.; Anonymous donation to the Medical College of Wisconsin; Be the Match Foundation; *Bristol Myers Squibb Oncology; *Celgene Corporation; *Chimerix Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech Inc.; Genzyme Corporation; *Gilead Sciences Inc.; Health Research Inc. Roswell Park Cancer Institute; HistoGenetics Inc.; Incyte Corporation; *Jazz Pharmaceuticals Inc.; Jeff Gordon Children’s Foundation; The Leukemia & Lymphoma Society; The Medical College of Wisconsin; Merck & Co Inc.; Mesoblast; *Millennium: The Takeda Oncology Co.; *Miltenyi Biotec Inc.; National Marrow Donor Program; Neovii Biotech NA Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions Inc.; Otsuka America Pharmaceutical Inc.; Otsuka Pharmaceutical Co, Ltd.—Japan; Oxford Immunotec; Perkin Elmer Inc.; Pharmacyclics; *Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; *Spectrum Pharmaceuticals Inc.; St. Baldrick’s Foundation; *Sunesis Pharmaceuticals Inc.; Swedish Orphan Biovitrum Inc.; Telomere Diagnostics Inc.; TerumoBCT; Therakos Inc.; University of Minnesota; and *Wellpoint Inc. Corporate Members have been denoted by the ‘*’ symbol.

Disclaimer

The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the US Government.

Author information

Author notes

  1. M Ramanathan, P Teira, M Battiwalla, J Barrett, K W Ahn, M Chen, J Green, M Laughlin, H M Lazarus, D Marks, A Saad, M Seftel, W Saber, B Savani, E K Waller, J Wingard, J J Auletta, C A Lindemans, M Boeckh and M L Riches: M Ramanathan, P Teira, M Battiwalla and J Barrett: Indicated authors were principal investigators and contributed equally to the study.

  2. Data contained in this manuscript have been previously reported as an oral abstract presentation at the 2014 56th American Society of Hematology Annual Meeting and Exposition (Abstract #47).

Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA

    M Ramanathan

  2. Sainte Justine Hospital, University of Montreal, Montreal, Canada

    P Teira

  3. Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA

    M Battiwalla & J Barrett

  4. Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA

    K W Ahn & W Saber

  5. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    K W Ahn & M Chen

  6. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    J Green

  7. Medical Director, Cleveland Cord Blood Center, Cleveland, OH, USA

    M Laughlin

  8. Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    H M Lazarus

  9. Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK

    D Marks

  10. Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    A Saad

  11. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

    M Seftel

  12. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    B Savani

  13. Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    E K Waller

  14. Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA

    J Wingard

  15. Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Host Defense Program, Nationwide Children’s Hospital, Columbus, OH, USA

    J J Auletta

  16. Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands

    C A Lindemans

  17. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    M Boeckh

  18. Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M L Riches

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for the Infection and Immune Reconstitution Working Committee of the Center for International Blood & Marrow Transplant Research

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Ramanathan, M., Teira, P., Battiwalla, M. et al. Impact of early CMV reactivation in cord blood stem cell recipients in the current era. Bone Marrow Transplant 51, 1113–1120 (2016). https://doi.org/10.1038/bmt.2016.89

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